Guidelines urge case-by-case handling of concussions

By Drew Joseph

Updated 11:17 pm, Monday, March 18, 2013

SAN FRANCISCO - The American Academy of Neurology, in its first new guidelines for managing concussions in sports since 1997, recommended Monday that any athlete with a suspected concussion be removed from play immediately and allowed to return gradually only after a health professional says all symptoms have disappeared.

The recommendations come as leagues from Pop Warner to the NFL are facing increasing pressure to address head injuries. A number of former NFL players who committed suicide were later found to suffer from chronic traumatic encephalopathy, a neurodegenerative disease thought to stem from repeated blows to the head.

At the same time, thousands of former NFL players have sued the league, with many saying the hits they took on the field have contributed to chronic neurological problems and disease.

In the most significant departure from the 1997 guidelines, the neurologists recommended that concussions be handled on a case-by-case basis.

The previous recommendations established three grades of concussion severity and provided time frames for when an athlete could return for each grade.

"We've moved away from the concussion-grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually," said Dr. Christopher Giza of UCLA, one of the report's lead authors. "There is no set timeline for safe return to play."

The researchers also found that the longer an athlete plays a sport and the number of concussions he or she receives might factor into any future chronic neurobehavioral problems.

But doctors emphasized a causative relationship between repeated concussions and future neurodegenerative disorders such as Alzheimer's disease has not been scientifically established.

The neurologists' report found that more than 1 million athletes suffer a concussion each year in the United States. Football and rugby presented the highest chances of concussion, followed by soccer and hockey. Girls faced the highest risk of concussion in soccer and basketball.